Fighting for Coverage: Patients caught in the middle of battle over staggering medical air transport bills

Doctors diagnosed Tamiko Wright while she was in Florida for her son’s wedding. Doctors in Florida recommended she be transferred immediately for treatment. (Photo courtesy Michael Wright)

INDIANAPOLIS (WTHR) — 13 Investigates has a call to action that could help you avoid a financial pitfall in the case of a medical emergency.

Our team uncovered system failures in Indiana when it comes to coverage for life-saving medical air transports. Patients in the throes of an emergency are hit with big bills when the transport used to save their lives is not in network with their insurance carrier.

Insurance companies might not cover what you think, and the transport providers could end up charging staggering amounts.

13 Investigates Reporter Sandra Chapman discovered why it is so important to fight to make sure you're covered before you need it.

Emergency medical flight to fight for life

Michael Wright never expected his wife Tamiko to return home to Indiana in a medical air transport.

In August 2015, she was put on a flight from the Gulf Coast Medical Center in Panama City, Florida to Methodist Hospital in Indianapolis.

"This was life and death and they wanted to send us back to Indianapolis," Michael Wright explained.

The couple had gone to Florida for his step-son's wedding.

Tamiko Wright smiles with two grandchildren.  She died in 2015, just weeks after being diagnosed with Acute Myeloid Leukemia and a serious infection in her arm. (Photo courtesy Michael Wright)
Tamiko Wright smiles with two grandchildren. She died in 2015, just weeks after being diagnosed with Acute Myeloid Leukemia and a serious infection in her arm. (Photo courtesy Michael Wright)

But a day after their arrival, Tamiko complained of arm pain and swelling. She went to a Med Check and was immediately sent to the emergency room at the Gulf Coast Medical Center. There doctors revealed a troubling diagnosis. Tamiko Wright was suffering from Acute Myeloid Leukemia and Clostridium Septicum, an infection that could have resulted in her losing her left arm.

Michael Wright says the Florida doctors weren't comfortable treating the combination of illnesses and arranged the transport to get her more specialized care closer to home.

"They didn't know what it was or even how to start treating it," Wright told 13 Investigates.

He never imagined using a medical air transport would put him in a world of hurt.

"I was in shock of the moment. You just do what the doctors are telling you and you just trust that it will be all taken care of and insurance will pay their part," he said, recalling those moments when the decision was made.

Tamiko underwent surgery and aggressive cancer treatments at Methodist Hospital.

But the complications were too severe. She died three weeks later. She was just 49 years old.

"So this really was life and death?" 13 Investigates Reporter Sandra Chapman asked Michael Wright.

"Oh yeah, absolutely," he responded.

But weeks after Tamiko's death, the grieving widower learned something regarding Anthem Insurance that left him angry.

Anthem had denied to pay for the coverage of the medical transport.

Anthem sent a letter to the Indiana Department of Insurance in response to a complaint filed by Air Trek and Michael Wright. Anthem wrote:

"We cannot approve coverage for flying Tamiko Wright to another place for medical care... The care she needed could have been given where she was... not medically necessary."

Anthem had already made a payment well over $15,000 but said, "Anthem paid on the air ambulance claim in error."

The insurer wanted a refund.

Wright couldn't believe it.

"It goes from a range of frustrated to angry to just I don't understand. You pay your premiums. You ought to have the coverage when you need it and you know the one time that we needed it, it wasn't there," he said.

The bill for that transport was astounding with a total charge of $162,225.

Air Trek has yet to say why the transport from Panama City to Indianapolis costs so much.

There was also a large disparity between the final bill and the initial bill that was only around $34,500.

Fingers point in all directions for rising air transportation costs

According to a 2017 Government Accountability Report, the median price of air transports was approximately $30,000 in 2014, double the price from 2010.

The air medical industry blames the government for the significant increase.

"7 out of 10 people flown by air medical are covered by Medicare or Medicaid or have no insurance," said Carter Johnson, a spokeswoman for the group SOAR, Save Our Air Medical Resources.

Johnson said the government is part of the problem by failing to adequately reimburse the flight companies. That additional cost is passed down to the roughly 30% of patients with private insurance.

"Insurers really need to do right by patients and cover these services," Johnson added.

Tony Felts, Senior Director of Public Relations for Anthem Blue Cross and Blue Shield, said some of these billing problems stem from provider network negotiations. He said, "Some [air transport providers] choose not to join our network, which allows these companies to charge customers unreasonable amounts above what is covered by insurance."

Stuck in the middle, holding the bill

When the insurance company doesn't pay, it means people like Michael Wright are caught in the middle, stuck with crushing bills.

"No one wants to see patients stuck in the middle," Carter Johnson said.

But that's exactly what's happening nationwide and right here in Indiana.

“They're not thinking and should not have to think about whether or not their transport is going to be paid for by their insurer”

Tim and Cathy Hoogenboom of Elkhart are facing roughly $40,000 in payments after their granddaughter was taken by air to a Fort Wayne hospital for a blood clot. Anthem agreed to pay just around $10,000 of the nearly $54,000 Rocky Mountain Holdings charged. Rocky Mountain Holdings was also considered out of network.

Johnson says when every second counts, families have little time to shop around for available transports in network.

"They're not thinking and should not have to think about whether or not their transport is going to be paid for by their insurer," she said.

As for Michael Wright, he's exhausted all of his appeals. Anthem is refusing to budge and so is Air Trek.

It means 3-years after his wife's death, Wright is still caught in the middle of a nightmare he can't afford.

"It's not like trying to get one over on them," he told 13 Investigates. "I was told this was what needed to happen."

Don't want for an emergency, do your research now

Michael O'Brien from the Indiana Association of Health Plans said it’s a good idea to get out your policies now and look to see what your insurer provides.

If it's not clear, contact your insurer and ask specifically which transport companies are in network. Keep that information handy in case of an emergency.

O'Brien said:

"The Indiana Association of Health Plans recognizes and appreciates the life-saving benefits air ambulance services can provide. On behalf of their patients, insurance companies take steps to make sure these expensive services are used only when medically appropriate.

We understand that it can be difficult to make those decisions in a true emergency, so those financial arrangements should be made before an emergency ever occurs. That is why it is imperative for providers to join insurance networks whenever practicable.

Doing so offers access to life-saving transportation in an emergency, brings predictability to provider reimbursement, and provides financial protection to their patients."

Congress is grappling with this issue and is asking transport companies to provide more information on their charges in hopes of creating guidelines.

If you have questionable charges you can also file a complaint with the Indiana Department of Insurance.